Provider Demographics
NPI:1841265923
Name:GREGUSH, EUGENE ERVIN (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:ERVIN
Last Name:GREGUSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 HARBOR BLVD
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5317
Mailing Address - Country:US
Mailing Address - Phone:941-624-3500
Mailing Address - Fax:941-625-6977
Practice Address - Street 1:2525 HARBOR BLVD
Practice Address - Street 2:SUITE 201A
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5317
Practice Address - Country:US
Practice Address - Phone:941-624-3500
Practice Address - Fax:941-625-6977
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041486207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068891600Medicaid
FL068891600Medicaid
FLD85711Medicare UPIN